Sam Houston Area Council - Camp Strake - Special Diet Request Form

Participants First Name *
Participants Last Name *
Unit # *
Attending Start Date *
First Name of Parent/Guardian *
Last Name of Parent/Guardian *
Phone *
Email *
Please identify and describe dietary restrictions in the space below. *
List all omitted foods. *
Please describe any foods that you need omitted from your meals.
List all Acceptable Substitutions *
Please describe any substitutions for the foods you need omitted.
I, as an authorized person to sign and enter into contracts on behalf of myself or child, understand, acknowledge and agree as follows: *
By typing your name in this field you are e-signing the information provided is correct on this form. Signature (if 18+) or Parent/Guardian Signature *
Date *